Neuropsychiatrie de l''Enfance et de l''Adolescence最新文献

Access to parenthood is not always easy, and various difficulties can sometimes emerge. Often underdiagnosed, these peri- and post-partum disorders have a major impact on the quality of early interactions. Prevention and fast care are fundamental. In Nancy, France, a mobile perinatal psychiatry team (EMPPer) was created in September 2021 with the aim of “reaching out” to these vulnerable populations with care access difficulties. A clinical case combining precariousness, migration, maternal psychopathological disorders, baby's psycho-affective and psychomotor development trouble is exposed. This article aims to present the multidisciplinary network intervention of EMPPer.

Introduction

In France, to benefit from appropriate medical, social and educational care, children with autism spectrum disorders must obtain a referral from the Maison Départementale des Personnes Handicapées (MDPH), and these notifications must then be implemented. In French Guiana, social and territorial inequalities in health are omnipresent. However, there are no data on the care of adolescents with Autism Spectrum Disorder in French Guiana.

Aim and methodology

The aim of the project was to explore the educational and medico-social pathways of children included in Guiana's autism spectrum disorder register since 2016 (who were living in Guiana in 2016 and whose ASD had been diagnosed before their 8th birthday) by means of a telephone interview and data collection at the MDPH. We included 52 young people aged 11 to 18, including 40 families contacted by telephone. The results obtained through the variables collected show that, despite a diagnosis made before the age of 8, only 29 young people (out of 47 completed) benefit from medical, social and educational care that coincides with the recommendations of the current Commission des droits et de l’autonomie des personnes handicapées (CDAPH).

Results

Of the 52 young people monitored, at least nine – or 17.3% – were not receiving any form of education. Thirty one young people were receiving medical, social, health and/or educational care at the time of the survey, compared with 16 who were not receiving any, mainly because they had been on a waiting list for an average of five years. In addition, 34% said they were not satisfied with the overall care their child received, mainly because of staff shortages.

Conclusion

In conclusion, in French Guiana, there is a significant gap between what is recommended to parents for their teenage child's care and what is actually possible.

Objective

The aim of this study was to identify the content of the stereotype of a child with a diagnosis of attention deficit disorder with or without hyperactivity (ADHD) among French neuropsychologists, and then to identify the factors associated with a stereotyped representation of ADHD.

Method

An online survey was conducted in France among 88 neuropsychologists working with children diagnosed with ADHD. Stereotypes were identified using differential semantic scales. In line with the Stereotype Content model, seven “competence” stereotypes and seven “warmth” stereotypes were assessed. Individual factors potentially associated with stereotyping included categorical and continuum beliefs, beliefs in high quality of life opportunities, feelings of professional usefulness, perceived general similarities and perceived specific similarities. Sociodemographic factors were also collected.

Results

Compared with neurotypical children, participants perceived children with an ADHD diagnosis as having more difficulty concentrating, being less competent at controlling their emotions, more extroverted, more irritable, more insolent, less competent at maintaining friendly relationships, less competent academically, more competent at sports, more warm-hearted and more arrogant. The more the participants perceived themselves to be similar to children with a diagnosis of ADHD, the fewer stereotypes they themselves reported. Neuropsychologists with the fewest years of experience, the most frequent contact with children diagnosed with ADHD and working in private practice reported a more stereotyped view of ADHD.

Conclusion

Even though neuropsychologists play an important role in supporting children with ADHD, many stereotypes can be found in their representation of the children they work with. These stereotypes are discussed, along with anti-stigma solution.

Context

Art-mediated activities and cultural care have become a component of most hospital institutions for children and adolescents. Yet their funding is not specified. Based on the experience of a university hospital department, we would like to consider measures that might encourage their continuation.

Methods

We conducted an observational study and interviews (n = 15) to list all the activities carried out by an external contributor in 2023, their themes, the target audience, their objectives, the nature of the contributors, the existence of a formalized agreement, funding, as well as their frequency and duration.

Results

Thirty-five different partners carried out 685 actions in 2023, 10% of which were carried out outside the hospital. The themes addressed are extremely varied (sports, performing arts, literature, visual arts, etc.). These activities represent an average of 210 interventions per unit, or 4 per week. However, they are less numerous in the intensive care unit and units for autistic patients with challenging behaviors, and virtually absent from outpatient units. Finally, specific funding or agreements are often absent.

Discussion

Despite their frequency and the substantial investment made by the team and its partners, there are a number of weaknesses. We are developing the idea that the creation of a cultural policy co-constructed between a cultural and sponsorship department and the clinical components (in our case, child psychiatry) would make it possible to resolve some of these weaknesses and promote a better inclusion in patient care.

Objective

The quality of the very early emotional experiences in a child's life are recognized today as foundational in the mental health of becoming an adult. Unsurprisingly, clinicians and health authorities agree on the importance of early detection and treatment of any mental health issues experienced by the preschool child. This is even more important and challenging as young children do not yet have the language skills necessary to express their distress. But do the caregivers in charge of these populations have the best tools at their disposal to carry out that important mission in an efficient and scientifically robust manner reflecting the latest research findings and scientific literature? This is the question we try to answer in this paper.

Method

We revisited the theoretical underpinnings behind the concept of mentalization as playing a key role in the ability to understand the other's inner reality. We then carried out an extensive review of scientific papers written over the past 30 years on the subject. We examined mental representations of the adult on the child and analyzed those mentalizations as key inputs. We focused on extracting cross analyses of the mentalizations of one child by several adults with different functions in the life of the child. In this process, we used the PRISMA methodology applied to large international medical databases.

Results

We found that the qualitative approach, usually associated with a lengthy process, has been overwhelmingly used in trying to assess patients’ mental states and to analyze the mentalizations on the patient, adult or child. Furthermore, cross analyses of mentalizations from more than one adult on a given child were almost nonexistent, despite having high epistemic and clinical potential.

Conclusions

There is a dearth of reliable quantitative tools, able to capture and analyze the mentalizations on a patient, that are scientifically robust, transposable, and easy to implement in a clinical setting. The absence of such tools for medical professionals in charge of assessing preschool children contributes, in our view, the low detection and poor treatment of mental disorders in that particularly vulnerable population. We believe there is here an urgent unmet need and that such tools should be designed, validated, and deployed into the target populations as early as possible.

In this article, we propose a reflection on the place of spontaneous creation in the therapeutic care of adolescents presenting a first episode of psychotic decompensation. Based on the clinical case of Emilio, 13 years old, and the examination of the productions produced during interviews, the act of creation is considered as a self-therapeutic attempt to adapt the world. The theoretical-clinical analysis of the transferential productions and positioning of the subject points to the possibility of emergence, at the initiative of the adolescent, of a place of address allowing this passage from an almost delusional private scenario to an authentic creation addressed to another becoming a witness to the authorship of the creation initiated by the subject. Therefore, the act of creation as addressed can be thought of as a possible compensatory elaboration coming to mask the deleterious effects of the lack of symbolic inscription of the psychotic adolescent. The act of compensatory creation, by generating a possible identity, even purely functional and stereotypical, for the subject thus allows the psychotic adolescent to once again enter into a bond with the other in a more peaceful manner.

Over the past year, several controversial articles have been written in the press and scientific journals about the benefits and harms of time-out (TO). The aim of this article is to review the scientific literature outlining the conclusions of meta-analyses carried out on parenting programs including TO, and on the TO procedure itself. Then, we describe the characteristics of the TO to understand how parents/educators use it and to assess its efficiency. The results show that the TO is not an isolated educational strategy but is included in a more comprehensive process with a before (establishment of the educational framework, rules to be followed) and an after (debriefing, explanations of inappropriate behavior) called time-in. Thus, it is difficult to assess the effectiveness of a TO without considering a wider temporality, including time-in. Moreover, the age of the child, the TO's duration and any behavioral or mental problems in the dyad child/parent are important factors that highlight the plurality of the TO. Further scientific research is necessary to assess its effectiveness considering the epidemiological characteristics of each protagonist. We need to look more closely at which TO is the best for which child and by which parent.

The article presents a new conceptualization of attachment – which is no longer envisaged as a general trait of the person but as relationship-specific behavioral and representational functioning – along several continua (security, deactivation, hyperactivation, and disorganization of the attachment system). The notion of ‘multiple models’ and its link with disorganized attachment are discussed. The author highlights the need to differentiate cases in which there are two contradictory representations of a same event from those in which distinct models exist for different relationships, the latter case – unlike the former – not being pathological. This conceptualization enables a finer examination of attachment processes in both practice and research. The Attachment Multiple Model Interview (AMMI) is presented with examples in clinical and research settings. It is now possible to disentangle the relative contribution of attachment to each figure whether with the mother, the father, another attachment figure (for example among placed children or among the elderly), a therapist, or a romantic partner. In addition to each one's specific role and their additive effects, the interaction effects of these different attachments can also account for counterbalancing mechanisms (resilience) in psychological development. Similarities across relationships (or rigid functioning) as well as variation can also be investigated.